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Fosfomycin Use in Treating Severe Difficult-to-Treat Gram-Negative Infections-A Comprehensive Review.

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Intravenous fosfomycin shows promise for treating severe infections caused by difficult-to-treat Gram-negative bacilli in critically ill patients. Further clinical trials are needed to confirm its efficacy and safety.

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Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Critical Care Medicine

Background:

  • Fosfomycin, an older antibiotic, is regaining relevance due to rising antimicrobial resistance.
  • Limited treatment options for severe Gram-negative bacilli (GNB) infections necessitate exploring alternative agents.

Purpose of the Study:

  • To review the use of intravenous (IV) fosfomycin in critically ill patients with severe infections.
  • To evaluate its efficacy and safety against difficult-to-treat (DTR) Gram-negative bacilli (GNB).

Main Methods:

  • Comprehensive literature review focusing on IV fosfomycin in critically ill patients.
  • Analysis of studies involving DTR GNB, including multidrug-resistant (MDR) strains.

Main Results:

  • IV fosfomycin demonstrates broad-spectrum activity and synergistic potential with other antimicrobials.
  • Favorable pharmacokinetic/pharmacodynamic (PK/PD) profile with good tissue penetration, including the CNS.
  • Effective in treating infections caused by extended-spectrum beta-lactamases (ESBLs) and carbapenemase-producing Enterobacterales (CRE).

Conclusions:

  • IV fosfomycin is a viable option for combination therapy in severe DTR GNB infections.
  • Further rigorous clinical trials are essential to optimize its use and define its safety profile.
  • Growing evidence supports its role in managing infections caused by multidrug-resistant pathogens.